Extra-articular scapular fractures: comparison of theoretical and actual treatment

Abstract

Background: Discrete radiographic thresholds of scapular fracture deformity proposed as a guide for when to utilize operative treatment are a matter of debate. The purpose of the present study was to determine how many patients would have received operative treatment according to these criteria and how many actually received operative treatment.

Methods: Three hundred and thirty patients with an extra-articular fracture of the scapula at two level 1 trauma centers were retrospectively analyzed. Glenopolar angle, translation, angulation and medial/lateral displacement were measured on computed tomogaphy scans or radiographs to determine the theoretical operative treatment recommendation according to Cole's criteria.

Results: Sixty-two patients (19%) had one or more radiographic indications for operative treatment, half of them had more than 20 mm of lateral displacement, and one fourth of them had substantial translation. No patients had operative treatment of the scapular body. Two patients had operative treatment of an acromion fracture, neither of which met radiographic criteria for surgery.

Conclusions: At least in our centres, there is a striking discrepancy between theoretical and actual recommendations for surgery. There is clearly a need for more research to determine whether patients are being undertreated or whether the guidelines are too stringent.

Keywords: 3D computed tomography; Cole’s criteria; extra-articular scapular fracture; operative treatment; radiographs.

Figure 1.

Measurement of the lateral displacement (mm) of the inferior body fragment in comparison to the superior fragment of the fracture on a 3D scapula, virtually rotated until the 3D model represents a true anteroposterior radiograph showing the largest width of the scapular body.

Figure 2.

The glenopolar angle was measured on the same true anteroposterior rotated 3D reconstruction as the angle between a line defined by the inferior and superior edges of the glenoid and a line defined by the superior edge of the glenoid and the inferior angle of the scapula.

Figure 3.

Measurement of angulation between the distal and proximal body main fragments on a rotated 3D scapula (Neer Y-view).

Figure 4.

Translation was measured between the anterior cortex of the proximal fragment and the anterior cortex of the distal fragment on the same scapular Y-view.